| NPI | 1518903608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 067961) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO R7H80) |
| 207W00000X Ophthalmology (Licence: NC 34436) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2018-06-13 |